| Pristine Pediatrics & Family Medicine Clinic Llc | |
|
13523 Hargrave Rd Houston TX 77070-3829 | |
| (281) 206-4496 | |
| (281) 206-4487 |
| Full Name | Pristine Pediatrics & Family Medicine Clinic Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 13523 Hargrave Rd, Houston, Texas |
| Authorized Official Name and Position | Iyabode Ogunlade (OWNER) |
| Authorized Official Contact | 2812064496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pristine Pediatrics & Family Medicine Clinic Llc 13523 Hargrave Rd Houston TX 77070-3829 Ph: (281) 206-4496 | Pristine Pediatrics & Family Medicine Clinic Llc 13523 Hargrave Rd Houston TX 77070-3829 Ph: (281) 206-4496 |
| NPI Number | 1427521525 |
|---|---|
| Provider Enumeration Date | 01/10/2019 |
| Last Update Date | 11/09/2020 |
| Medicare PECOS PAC ID | 2163853193 |
|---|---|
| Medicare Enrollment ID | O20200507001502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427521525 | NPI | - | NPPES |
| 411162702 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Iyabode M Ogunlade |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1366679573 PECOS PAC ID: 3678625613 Enrollment ID: I20090722000258 |
| Provider Name | Ashraf Elmeery |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477832442 PECOS PAC ID: 4981821956 Enrollment ID: I20200528001738 |
| Provider Name | Marissa Garcia Langford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619350378 PECOS PAC ID: 5799151973 Enrollment ID: I20221012002611 |
| Provider Name | Hima Bodagala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821408329 PECOS PAC ID: 5991015034 Enrollment ID: I20230925000713 |
| Provider Name | Mary Ekemini Itauma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427749118 PECOS PAC ID: 3870937527 Enrollment ID: I20240221001392 |
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